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Umławska W, Pawłowska-Seredyńska K, Goździk M, Porębska I. Early Changes in Nutritional Status of Elderly Patients with Lung Cancer Undergoing Chemotherapy Are Positively Related with Symptoms of Depression: A Prospective Follow-Up Study. Nutr Cancer 2024; 76:927-935. [PMID: 38973245 DOI: 10.1080/01635581.2024.2375019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
This study aims to assess early effects of chemotherapy on symptom alleviation, nutritional status, and mental health in elderly patients with advanced non-small-cell lung cancer (NSCLC). This prospective study included 45 NSCLC patients (32 males, 13 females) aged 65-82 years (mean age 70.0 ± 4.5 years) with good performance status. Assessments were conducted immediately after diagnosis and after two chemotherapy cycles, focusing on nutritional status (assessed with MNA questionnaire), quality of life (QoL, based on FACT-L and FACT-TOI questionnaires), lung cancer-related symptoms (based on LCSS), and mental health (based on PHQ-9 questionnaire). Despite significant alleviation of symptoms like cough, dyspnea, and body weight loss, there was no significant correlation between changes in symptoms burden and changes in nutritional status (r2 = 0.122, P = 0.427), and change of patients' mental condition (r2 = -0.141, P = 0.255). No significant QoL changes were noted, but a decrease in severe depression frequency was observed. The improvement of patients' mental condition was related strictly to the improvement of nutritional status (r2 = -0.589, P < 0.001). The study highlights the vital link between nutritional status and mental health in elderly NSCLC patients, emphasizing the need for integrated care approaches that address both aspects to enhance treatment effectiveness and patient well-being.
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Affiliation(s)
- Wioleta Umławska
- Department of Human Biology, University of Wrocław, Wrocław, Poland
| | | | - Malwina Goździk
- Department of Human Biology, University of Wrocław, Wrocław, Poland
| | - Irena Porębska
- Department of Pulmonology and Lung Oncology, Wrocław Medical University, Wrocław, Poland
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2
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Zeng Y, Hu CH, Li YZ, Zhou JS, Wang SX, Liu MD, Qiu ZH, Deng C, Ma F, Xia CF, Liang F, Peng YR, Liang AX, Shi SH, Yao SJ, Liu JQ, Xiao WJ, Lin XQ, Tian XY, Zhang YZ, Tian ZY, Zou JA, Li YS, Xiao CY, Xu T, Zhang XJ, Wang XP, Liu XL, Wu F. Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer. Nat Med 2024; 30:1680-1688. [PMID: 38740994 PMCID: PMC11186781 DOI: 10.1038/s41591-024-02929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
Emotional distress (ED), commonly characterized by symptoms of depression and/or anxiety, is prevalent in patients with cancer. Preclinical studies suggest that ED can impair antitumor immune responses, but few clinical studies have explored its relationship with response to immune checkpoint inhibitors (ICIs). Here we report results from cohort 1 of the prospective observational STRESS-LUNG study, which investigated the association between ED and clinical efficacy of first-line treatment of ICIs in patients with advanced non-small-cell lung cancer. ED was assessed by Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. The study included 227 patients with 111 (48.9%) exhibiting ED who presented depression (Patient Health Questionnaire-9 score ≥5) and/or anxiety (Generalized Anxiety Disorder 7-item score ≥5) symptoms at baseline. On the primary endpoint analysis, patients with baseline ED exhibited a significantly shorter median progression-free survival compared with those without ED (7.9 months versus 15.5 months, hazard ratio 1.73, 95% confidence interval 1.23 to 2.43, P = 0.002). On the secondary endpoint analysis, ED was associated with lower objective response rate (46.8% versus 62.1%, odds ratio 0.54, P = 0.022), reduced 2-year overall survival rate of 46.5% versus 64.9% (hazard ratio for death 1.82, 95% confidence interval 1.12 to 2.97, P = 0.016) and detriments in quality of life. The exploratory analysis indicated that the ED group showed elevated blood cortisol levels, which was associated with adverse survival outcomes. This study suggests that there is an association between ED and worse clinical outcomes in patients with advanced non-small-cell lung cancer treated with ICIs, highlighting the potential significance of addressing ED in cancer management. ClinicalTrials.gov registration: NCT05477979 .
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Affiliation(s)
- Yue Zeng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chun-Hong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China
| | - Yi-Zheng Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Jian-Song Zhou
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shu-Xing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Meng-Dong Liu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Zhen-Hua Qiu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Ma
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chun-Fang Xia
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu-Rong Peng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ao-Xi Liang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sheng-Hao Shi
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Jiao Yao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Qi Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Jie Xiao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiao-Qiao Lin
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xin-Yu Tian
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Ying-Zhe Zhang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhuo-Ying Tian
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ji-An Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yun-Shu Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao-Yue Xiao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tian Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Jie Zhang
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiao-Ping Wang
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xian-Ling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China.
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
- Hunan Key Laboratory of Early Diagnosis and Precision Therapy in Lung Cancer, The Second Xiangya Hospital, Central South University, Changsha, China.
- FuRong Laboratory, Changsha, China.
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DSilva F, Singh P, Javeth A. Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review. J Palliat Care 2023; 38:432-455. [PMID: 36245333 DOI: 10.1177/08258597221131133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.
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Affiliation(s)
- Fatima DSilva
- Nitte Usha Institute of Nursing Sciences, Nitte University, Mangalore, Karnataka, India
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
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Peng Z, Wang C, Sun Y, Ma Y, Wang J, Xu F, Xu X, Chen Y. Depression and anxiety in cancer patient enrolled in clinical trials with serious adverse events. Cancer Med 2023; 12:20015-20026. [PMID: 37723836 PMCID: PMC10587935 DOI: 10.1002/cam4.6556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Drug-induced side effects, particularly serious adverse events (SAEs), often affect cancer patients enrolled in clinical trials. However, little is known about anxiety and depression in cancer patients who experienced SAEs. This study evaluated the prevalence of anxiety and depression in cancer patients enrolled in clinical trials who experienced SAEs and explored the risk factors. METHODS A multi-center, cross-sectional survey was conducted in hospitals affiliated with the University of Science and Technology of China from December 2021 to November 2022. A total of 112 cancer patients who experienced SAEs while enrolled in clinical trials, and who completed the informed consent process and study questionnaires, were included in the final analysis. RESULTS The rate of moderate-severe depression in cancer patients was 38.4% and that of moderate-severe anxiety was 13.4%. Among the patients who had moderate-severe anxiety, 93.3% had concurrent moderate-severe depression. Lower cognitive function and lower global quality of life were risk factors for depression in cancer patients who experienced SAEs. Pain, low emotional function, low global quality of life, and a high Impact of Events Scale score were risk factors for anxiety. CONCLUSIONS Cancer patients enrolled in a clinical trial who experienced SAEs tended to be anxious and depressed, particularly the latter. These results indicate the need to evaluate anxiety and depression, and mental health treatment among cancer patients with SAEs in clinical trials.
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Affiliation(s)
- Zhen Peng
- Division of Life Sciences and Medicine, Drug Clinical Trial Institution, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaAnhuiHefeiChina
| | - Chongwei Wang
- Division of Life Sciences and Medicine, Drug Clinical Trial Institution, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaAnhuiHefeiChina
| | - Yubei Sun
- Division of Life Sciences and Medicine, Department of Oncology, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Yan Ma
- Division of Life Sciences and Medicine, Department of Rheumatology and Immunology, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Jumei Wang
- Division of Life Sciences and Medicine, Department of Endocrinology, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Fei Xu
- Division of Life Sciences and Medicine, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Xiaoling Xu
- Division of Life Sciences and Medicine, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Yin Chen
- Division of Life Sciences and Medicine, Department of Scientific Research, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina
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Deng Q, Kang L, Zhu S, Luo W, Qing J, Zhong S, Wu Y, Lu J, Dong H. Effects of nursing based on Orem's self-care model on self-care efficacy, quality of life and adverse emotions in patients with advanced lung cancer. Am J Transl Res 2021; 13:2983-2989. [PMID: 34017465 PMCID: PMC8129333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effects of nursing based on Orem's self-care model on self-care efficacy, quality of life (QOL) and adverse emotions of patients with advanced lung cancer (ALC) receiving chemotherapy. METHODS A total of 71 patients with ALC aged 50-70 years, from our hospital were selected as the study subjects and divided into the control group (CNG, n = 35) and the experimental group (EXG, n = 36) using the random number table method. The CNG was treated with conventional chemotherapy combined with conventional nursing, while the EXG was treated with conventional chemotherapy combined with nursing based on Orem's self-care model. The effects on self-care efficacy, QOL and adverse emotions in the two groups were observed before and after nursing. The General Self-Efficacy Scale (GSES) was scored in both groups. The patients' body, physiology, psychology, society and health were scored using the QOL questionnaire for Chinese cancer patients receiving chemotherapy (QLQ-CCC). The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) in the two groups were scored using the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). RESULTS The GSES scores in the EXG were remarkably higher than those in the CNG after intervention (P < 0.05). After intervention, the scores of the patients' body, physiology, psychology, society and health in the EXG were higher than those in the CNG (P < 0.05). The scores of SAS and SDS in the EXG were lower than those in the CNG (P < 0.05). CONCLUSION Nursing based on Orem's self-care model can effectively improve the self-care efficacy and QOL, adverse emotions (e.g., anxiety and depression), and degree of pain of patients with ALC receiving chemotherapy. Therefore, it has a positive clinical significance.
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Affiliation(s)
- Qiuhua Deng
- Respiratory Medicine Department, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Ling Kang
- Hepatological Surgery Department, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Shunfang Zhu
- Respiratory Medicine Department, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Wang Luo
- Respiratory Medicine Department, Zengcheng Branch, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Jingmei Qing
- Respiratory Medicine Department, Zengcheng Branch, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Shuhua Zhong
- Respiratory Medicine Department, Zengcheng Branch, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Yantao Wu
- Respiratory Medicine Department, Zengcheng Branch, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Jieying Lu
- Respiratory Medicine Department, Zengcheng Branch, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
| | - Hangming Dong
- Respiratory Medicine Department, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong Province, China
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Sha Z, He JB, Jiang Q, Xu L, Hu L, Liang Z, Li T, Lin Z, Yu Q, Pei X, Lv W. Clinical observation of Pemetrexed first-line treatment in advanced non-squamous lung cancer or non-small cell lung cancer without driver-mutations: a phase 2, single-arm trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1315. [PMID: 33209895 PMCID: PMC7661875 DOI: 10.21037/atm-20-6539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Non-dominant population, which means patients with advanced non-squamous lung cancer or non-small cell lung cancer (NSCLC) without driver-mutations, who are excluded from clinical studies because of specific baseline conditions refractory to multiple treatments, have poor outcomes. We assessed the activity of pemetrexed first-line treatment for a non-dominant population, explore the safety and efficacy of pemetrexed therapy. Methods We did this two-phased, single-arm trial at two sites at the Fifth Affiliated Hospital of Sun Yat-sen University and Guangxi medical university cancer hospital. Pemetrexed 500 mg/m2, static drops on day 1; 21 days for a cycle, each treatment for at least two cycles and up to six cycles. Efficacy was assessed every two cycles. Results We counted the July 21, 2018 to 2020 on May 31, first diagnosed with IIIb–IV period (American Joint Committee on Cancer eighth edition) no drive genes, non-squamous cell carcinomas, 30 patients with non-small cell lung cancer, the follow-up to July 31, 2020, median follow-up time was 12 months. Most were elderly patients with poor general conditions (96.7% of patients had ECOG scores of 2–3) (median age 66 years). Median duration of maintenance treatment was 6 months. Median progression-free survival was 6.5 months. Median overall survival was 12 months. Patients with performance status =0–2 had a significantly higher median overall survival time (16 months) compared with patients with performance status =3 who had a median overall survival time of 7 months (P=0.001). Most treatment-related adverse events were grade 1 or grade 2. Conclusions This study is the first to investigate the survival benefit and toxicity tolerance of pemetrexed treatment in non-dominant population in the real world, providing a new therapeutic possibility for those who failed to be enrolled in clinical studies.
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Affiliation(s)
- Zhou Sha
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jian-Bo He
- Guangxi Medical University Cancer Hospital, Nanning, China
| | - Qinling Jiang
- Department of Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Linlin Xu
- Guangxi Medical University Cancer Hospital, Nanning, China
| | - Liyang Hu
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zibin Liang
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Tin Li
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhong Lin
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Qitao Yu
- Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiaofeng Pei
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Weize Lv
- Department of Thoracic Oncology, The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Zhang Z, Min X. The Ethical Dilemma of Truth-Telling in Healthcare in China. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:337-344. [PMID: 32394322 DOI: 10.1007/s11673-020-09979-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and culture are also discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations.
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Affiliation(s)
- Zanhua Zhang
- Department of Emergency Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China
| | - Xiaoyan Min
- Department of Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China.
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Cao X, Gu Y, Bian S, Zhang Q, Meng G, Liu L, Wu H, Zhang S, Wang Y, Zhang T, Wang X, Sun S, Wang X, Jia Q, Song K, Niu K. Association between eating speed and newly diagnosed nonalcoholic fatty liver disease among the general population. Nutr Res 2020; 80:78-88. [PMID: 32736293 DOI: 10.1016/j.nutres.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/09/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Fast eating speed is a risk factor for obesity, which is also closely related to nonalcoholic fatty liver disease (NAFLD), suggesting that fast eating speed may contribute to the development of NAFLD. But the extent to which obesity may mediate the association between eating speed and NAFLD is uncertain. We hypothesized that obesity plays a mediating role in the association between eating speed and prevalence of NAFLD in the general population. A cross-sectional study (n = 23,611) was conducted in a general population sample from Tianjin, China. We measured anthropometrics and biochemical variables. The self-reported eating speed per meal was recorded and classified into 4 categories: slow, medium, relatively fast, and very fast. NAFLD was diagnosed by liver ultrasonography. Multiple logistic regression analysis was used to assess the associations between the eating speed and the prevalence of NAFLD, as well as the mediation effects of obesity on the association between eating speed and NAFLD. The prevalence of newly diagnosed NAFLD was 19.0%. After adjusting for potentially confounding factors, the odds ratios (95% confidence interval) of NAFLD across categories of eating speed were 1.00 (reference), 1.39 (1.18-1.64), 1.71 (1.45-2.01), and 2.04 (1.70-2.46). All these significant odds ratios were attenuated to be nonsignificant by adjustment for body mass index and/or waist circumference. This is the first study to demonstrate that eating speed is not independently associated with increased risk of NAFLD.
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Affiliation(s)
- Xingqi Cao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shanshan Bian
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yawen Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tingjing Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuena Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Wang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
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9
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Ponce Aix S, Talbot D, Govindan R, Dols MC, Postmus PE, Lewanski C, Bennouna J, Fischer JR, Juan-Vidal O, Stewart DJ, Ardizzoni A, Bhore R, Wolfsteiner M, Reck M, Ong TJ, Morgensztern D. Quality of life with second or third line nab-paclitaxel-based regimens in advanced non-small-cell lung cancer. Future Oncol 2020; 16:749-762. [PMID: 32228198 DOI: 10.2217/fon-2019-0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Evaluate quality of life (QoL) in patients with advanced non-small cell lung cancer treated with second or third line nab-paclitaxel ± durvalumab. Patients & methods: Longitudinal QoL was assessed using Lung Cancer Symptom Scale, EuroQoL Five-Dimensions Five-Levels and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core. Results: QoL was generally stable through eight treatment cycles (both arms). Clinically meaningful improvement from baseline was noted in Lung Cancer Symptom Scale (overall constitutional score and three-item index [nab-paclitaxel + durvalumab]) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (global health status/QoL and emotional functioning [both arms] and pain [nab-paclitaxel + durvalumab]) analyses. EuroQoL Five-Dimensions Five-Levels domains were stable/improved or completely resolved at least once in 19-56% and 9-51% of patients, respectively. Conclusion: While QoL trends were promising, additional data are required to support these regimens in this setting.
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Affiliation(s)
- Santiago Ponce Aix
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Denis Talbot
- Department of Medical Oncology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, UK
| | - Ramaswamy Govindan
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Manuel Cobo Dols
- Department of Medical Oncology, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Pieter E Postmus
- Department of Medical Oncology, The Clatterbridge Cancer Centre, Liverpool, UK
| | - Conrad Lewanski
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Jaafar Bennouna
- Department of Medical Oncology, Centre René Gauducheau Centre de Lutte Contre Le Cancer Nantes Atlantique, Nantes, Loire-Atlantique, France
| | - Juergen R Fischer
- Department of Medical Oncology, Lungenklinik Löwenstein gGmbH, Löwenstein, Baden-Württemberg, Germany
| | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David J Stewart
- Department of Medical Oncology, Ottawa Hospital, Ottawa, ON, Canada
| | - Andrea Ardizzoni
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Di Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | | | | | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Daniel Morgensztern
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
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10
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Cao X, Gu Y, Fu J, Vu TQC, Zhang Q, Liu L, Meng G, Yao Z, Wu H, Bao X, Zhang S, Wang X, Sun S, Zhou M, Jia Q, Song K, Wu Y, Niu K. Excessive daytime sleepiness with snoring or witnessed apnea is associated with handgrip strength: a population-based study. QJM 2019; 112:847-853. [PMID: 31297519 DOI: 10.1093/qjmed/hcz178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/01/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia is emerging as an important public health problem, and evidences have determined that poor sleep is associated with muscle strength, but the potential effects of excessive daytime sleepiness (EDS), snoring and witnessed apnea on handgrip strength have not been evaluated. AIM We aimed to examine the association between EDS, snoring, witnessed apnea and muscle strength in an adult population. DESIGN Cross-sectional study. METHODS This cross-sectional study comprised 19 434 adults. Handgrip strength was measured using a handheld digital dynamometer. EDS was assessed by Epworth Sleepiness Scale, snoring and witnessed apnea during sleep were reported through simple yes/no questions. Analysis of covariance was carried out to determine the association between EDS with snoring or witnessed apnea and muscle strength. RESULTS The means (95% confidence interval) for average handgrip strength/body weight (kg/kg) across symptoms categories were 0.396 (0.333-0.472), 0.393 (0.330-0.467), 0.396 (0.333-0.471) and 0.386 (0.325-0.460) (P < 0.0001), respectively. Similar results were observed with maximal handgrip strength/body weight (kg/kg). CONCLUSIONS Self-reported EDS accompanied with snoring or apnea is associated with lowest handgrip strength, independently of confounding factors. Whether improvement of EDS, snoring and apnea, can ameliorate age-associated decline in muscle strength warrants further studies.
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Affiliation(s)
- X Cao
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Y Gu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - J Fu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - T Q C Vu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Q Zhang
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - L Liu
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - G Meng
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Z Yao
- Tianjin Institute of Health and Environmental Medicine, 1 Dali Road, Heping District, Tianjin 300050, China
| | - H Wu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - X Bao
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - S Zhang
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - X Wang
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - S Sun
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - M Zhou
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Q Jia
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - K Song
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Y Wu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - K Niu
- From the Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Health Management Centre, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
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11
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Jin H, Peng X, Zhang C. Pre-injury level of anxiety is associated with the rate of digit replant failure: A prospective cohort study. Int J Surg 2019; 69:84-88. [DOI: 10.1016/j.ijsu.2019.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/04/2019] [Accepted: 07/22/2019] [Indexed: 11/24/2022]
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12
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Tan H, Chen S, Ercolano E, Lazenby M, Davies M, Chen J, McCorkle R. The prevalence and related factors associated with psychosocial distress among 420 hospitalised lung cancer patients in China: A case study. Eur J Cancer Care (Engl) 2019; 28:e13046. [PMID: 31016811 DOI: 10.1111/ecc.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
Abstract
Previous studies have reported high prevalence of psychosocial distress among lung cancer patients in Western countries, but the prevalence of distress in Chinese patients is not established. The study objectives were to report the prevalence of and factors associated with psychosocial distress in a sample of hospitalised patients in China and to implement distress screening in one thoracic specialty department. In this cross-sectional study, adult patients completed a self-reported demographic and clinical questionnaire and the distress thermometer with the problem list. Distress was dichotomised (high vs. low) and compared. Regression analyses were used to determine which variables were associated with psychosocial distress. One hundred eighty-six of 420 patients (38.6%) reported distress ≥4/10. They were unemployed, had New Rural Cooperative Medical System (NRCMS) insurance and Stage IV cancer. NRCMS insurance contributed to the likelihood of high distress and worry. Patients reported significant psychosocial distress during hospitalisation related to practical, emotional and physical problems. In this case study, staff reported they screened consecutive patients but there were no available referrals after discharge. We concluded it may be premature to screen patients for distress prior to instituting resources to establish services. To do otherwise is premature in ensuring patients' relief.
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Affiliation(s)
- Hui Tan
- Department Of Thoracic Neoplasm Chemotherapy, Hunan Cancer Hospital, The Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.,Yale University School of Nursing, West Haven, Connecticut
| | - Sijuan Chen
- Yale University School of Nursing, West Haven, Connecticut
| | | | - Mark Lazenby
- Yale University School of Nursing, West Haven, Connecticut
| | | | - Jianhua Chen
- Department Of Thoracic Neoplasm Chemotherapy, Hunan Cancer Hospital, The Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Ruth McCorkle
- Yale University School of Nursing, West Haven, Connecticut
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13
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Geerse OP, Brandenbarg D, Kerstjens HAM, Berendsen AJ, Duijts SFA, Burger H, Holtman GA, Hoekstra-Weebers JEHM, Hiltermann TJN. The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer. Lung Cancer 2019; 130:101-107. [PMID: 30885329 PMCID: PMC7026622 DOI: 10.1016/j.lungcan.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The use of patient-reported outcome measures is increasingly advocated to support high-quality cancer care. We therefore investigated the added value of the Distress Thermometer (DT) when combined with known predictors to assess one-year survival in patients with lung cancer. METHODS All patients had newly diagnosed or recurrent lung cancer, started systemic treatment, and participated in the intervention arm of a previously published randomised controlled trial. A Cox proportional hazards model was fitted based on five selected known predictors for survival. The DT-score was added to this model and contrasted to models including the EORTC-QLQ-C30 global QoL score (quality of life) or the HADS total score (symptoms of anxiety and depression). Model performance was evaluated through improvement in the -2 log likelihood, Harrell's C-statistic, and a risk classification. RESULTS In total, 110 patients were included in the analysis of whom 97 patients accurately completed the DT. Patients with a DT score ≥5 (N = 51) had a lower QoL, more symptoms of anxiety and depression, and a shorter median survival time (7.6 months vs 10.0 months; P = 0.02) than patients with a DT score <5 (N = 46). Addition of the DT resulted in a significant improvement in the accuracy of the model to predict one-year survival (P < 0.001) and the discriminatory value (C-statistic) marginally improved from 0.69 to 0.71. The proportion of patients correctly classified as high risk (≥85% risk of dying within one year) increased from 8% to 28%. Similar model performance was observed when combining the selected predictors with QoL and symptoms of anxiety or depression. CONCLUSIONS Use of the DT allows clinicians to better identify patients with lung cancer at risk for poor outcomes, to further explore sources of distress, and subsequently personalize care accordingly.
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Affiliation(s)
- O P Geerse
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands.
| | - D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - S F A Duijts
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands; Amsterdam University Medical Center, Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - G A Holtman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, the Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), The Netherlands
| | - T J N Hiltermann
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
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14
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Shahedah KK, How SH, Jamalludin AR, Mohd Faiz MT, Kuan YC, Ong CK. Depressive Symptoms in Newly Diagnosed Lung Carcinoma: Prevalence and Associated Risk Factors. Tuberc Respir Dis (Seoul) 2018; 82:217-226. [PMID: 30841021 PMCID: PMC6609524 DOI: 10.4046/trd.2018.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/14/2018] [Accepted: 10/16/2018] [Indexed: 01/07/2023] Open
Abstract
Background Depression is a recognized complication of lung cancer underreported in developing countries such as Malaysia. Treating and identifying depression in cancer patients increases survival and quality of life. Our objectives are to study prevalence of depressive symptoms in newly diagnosed lung carcinoma, and examine the relationship of depressive symptoms with other influencing risk factors. Methods A 2-year, cross sectional study February 2015–February 2017, was conducted at Hospital Tengku Ampuan Afzan, and Penang General Hospital. One hundred and three patients with newly diagnosed, biopsy confirmed primary lung carcinoma were recruited. Self-rated patient's identification sheet, validated Center for Epidemiologic Studies Depression (CES-D), and Dukes University Religion Index score from three different main languages were used. Results Prevalence of current depressive symptoms (CES-D total score ≥16) is 37.9%. The result suggests prevalence of those at high risk of moderate to major depression, may need treatment. Multivariate analysis reveals those with good Eastern Cooperation Oncology Group factor (η2=0.24, p<0.001) married (η2=0.14, p<0.001) with intrinsic religiosity (IR) (η2=0.07, p<0.02) are more resistant to depression. Conclusion One in three of lung carcinoma patients, are at increased risk for depression. Clinicians should be aware that risk is highest in those with poor performance status, single, and with poor IR. We suggest routine screening of depression symptoms as it is feasible, to be performed during a regular clinic visit with immediate referral to psychiatrist when indicated.
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Affiliation(s)
- K K Shahedah
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia.
| | - S H How
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
| | - A R Jamalludin
- Department of Community Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
| | - M T Mohd Faiz
- Department of Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
| | - Y C Kuan
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
| | - C K Ong
- Department of Respiratory Medicine, Penang General Hospital, George Town, Malaysia
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15
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Sato N, Hasegawa Y, Saito A, Motoi F, Ariake K, Katayose Y, Nakagawa K, Kawaguchi K, Fukudo S, Unno M, Sato F. Association between chronological depressive changes and physical symptoms in postoperative pancreatic cancer patients. Biopsychosoc Med 2018; 12:13. [PMID: 30288172 PMCID: PMC6162953 DOI: 10.1186/s13030-018-0132-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Pancreatic cancer (PC) has poorer prognosis and higher surgical invasiveness than many other cancers, with associated psychiatric symptoms including depression and anxiety. Perioperative depression has not been investigated in PC patients regarding surgical stress and relevant interventions. Methods We evaluated chronological depressive changes and subjective physical symptoms in surgically treated PC patients preoperatively and at 3 and 6 months postoperatively. Enrolled patients undergoing pancreatic tumor surgery completed questionnaires based on the Self-Rating Depression Scale (SDS) and Functional Assessment of Cancer Therapy for Patients with Hepatobiliary Cancer (FACT-Hep) preoperatively, and at 3 and 6 months postoperatively. Responses were analyzed with JMP® Pro using one-way and two-way ANOVA, Spearman’s rank correlation coefficient, and multiple regression analysis. Results Malignancy was diagnosed in 73 of 101 patients postoperatively; SDS score was significantly higher in these patients than in those with benign tumors at all timepoints: malignant/benign, 41.8/37.9 preoperatively (p = 0.004); 43.5/37.8 3 months postoperatively (p = 0.006); and 42.9/37.7 6 months postoperatively (p = 0.020). SDS scores were significantly higher in patients < 65 years old with malignancy at 3 months than at 6 months postoperatively (44.6/42.5, p = 0.046) and in patients with malignancy who underwent pancreaticoduodenectomy at 3 months postoperatively than preoperatively (43.4/41.1; p = 0.028). SDS scores moderately correlated with 8 physical symptom-related FACT-Hep items 3 months postoperatively (p < 0.05), showing low-to-moderate correlation with 16 physical symptom-related FACT-Hep items at 6 months postoperatively (p < 0.05). Multiple regression analysis of FACT-Hep symptoms significantly correlated with SDS scores revealed the following significant variables: “lack of energy” (p < 0.000) and “pain” (p = 0.018) preoperatively (R2 = 0.43); “able to perform usual activities” (p = 0.031) and “lack of energy” (p < 0.000) at 3 months postoperatively (R2 = 0.51); and “stomach swelling or cramps” (p = 0.034) and “bowel control” (p = 0.049) at 6 months postoperatively (R2 = 0.52). Conclusions PC patients experience persistently high levels of depression preoperatively through 6 months postoperatively, with associated subjective symptoms including pain and gastrointestinal symptoms. Trial registration UMIN Clinical Trials Registry 000009592, Registered 20 December 2012.
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Affiliation(s)
- Naoko Sato
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan.,5Department of Oncology Nursing, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575 Japan
| | - Yoshimi Hasegawa
- 2Department of Nursing, Tohoku University School of Health Sciences, Sendai, Japan
| | - Asami Saito
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fuyuhiko Motoi
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kyohei Ariake
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Katayose
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Kawaguchi
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin Fukudo
- 4Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumiko Sato
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Ruiz J, Miller AA, Tooze JA, Crane S, Petty WJ, Gajra A, Klepin HD. Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age. J Geriatr Oncol 2018; 10:48-54. [PMID: 30005982 DOI: 10.1016/j.jgo.2018.06.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improved assessment strategies are needed to individualize treatment for adults of all ages receiving palliative chemotherapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate the utility of the Fried Frailty Index (FFI) and a cancer-specific geriatric assessment (GA) to predict chemotherapy toxicity and overall survival (OS). METHODS We conducted a multi-site pilot study of 50 patients with newly diagnosed advanced NSCLC, age ≥ 18 years. All participants received carboplatin AUC 6, paclitaxel 200 mg/m2 every 3 weeks. FFI and the GA were administered prior to chemotherapy. A GA toxicity risk score was calculated. Grade 3-5 toxicity was assessed during 1st two cycles of chemotherapy. OS was measured from chemotherapy initiation. Logistic regression and Cox proportional hazards models were fit to estimate the association between baseline characteristics and toxicity and OS respectively. RESULTS Among 50 participants, 48 received chemotherapy and were evaluable. The mean age was 68.5 y (range 42-86), 79% male, 85% KPS ≥80. The median OS was 8 months. Many (27%) met FFI criteria for frailty with ≥3 impairments. Impairments detected by the GA were common. In multivariable analyses both FFI ≥ 3 and GA toxicity risk score > 7 were independently associated with higher odds of toxicity (Odds ratio [OR] 7.0; 95% confidence interval [CI] 1.1-44.6 and OR 4.3; 95% CI 1.0-17.7, respectively) in first cycle chemotherapy. Neither score was associated with OS. CONCLUSIONS Frailty predicts chemotherapy toxicity during first cycle. Frailty assessment may inform toxicity risk regardless of chronologic age.
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Affiliation(s)
- Jimmy Ruiz
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Antonius A Miller
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sandrine Crane
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William J Petty
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ajeet Gajra
- Department of Medicine, Syracuse VA Medical Center, Hematology/Oncology, Syracuse, NY USA
| | - Heidi D Klepin
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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17
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Presley CJ, Han L, Leo-Summers L, Hurria A, Gross CP, Davidoff AJ, Allore HG, Gill TM. Functional trajectories before and after a new cancer diagnosis among community-dwelling older adults. J Geriatr Oncol 2018; 10:60-67. [PMID: 29937422 DOI: 10.1016/j.jgo.2018.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/08/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND To characterize functional trajectories in the year before and after a new cancer diagnosis among older adults and to identify risk factors for worsening disability post-diagnosis. METHODS We identified 170 participants 70+ years with monthly assessments of thirteen basic, instrumental, and mobility activities and with a new cancer diagnosis from 1998 to 2014. A group-based trajectory model identified distinct functional trajectories based on a total disability score during the twelve months pre- and post-diagnosis. We evaluated associations between potential risk factors at the time of cancer diagnosis and worsening disability post-diagnosis, explored functional transitions from pre- to post-diagnosis and identified participants whose functional trajectories worsened. RESULTS Three pre-diagnosis functional trajectories were identified among 170 participants (mean age at diagnosis: 83 years (range: 73-105 years): mild, moderate, and severe disability. Three post-diagnosis functional trajectories were identified among 158 non-decedents: mild, moderate, and severe disability. Most participants (93.9%) with severe disability pre-diagnosis had severe disability post-diagnosis. Risk factors independently associated with worsening disability post-diagnosis included moderate or severe disability pre-diagnosis (adjusted risk ratio, aRR: moderate: 2.96; 95%CI: 2.11-4.16; severe: 5.11; 95%CI: 3.07-8.52) vs. mild (reference), poor physical capability (aRR: 1.57; 95%CI: 1.07-2.30), and incurable stage (aRR:1.99; 95%CI: 1.41-2.80). 40% of participants with a mild or moderate disability trajectory pre-diagnosis transitioned to a worse functional trajectory post-diagnosis. CONCLUSION Older adults followed distinct functional trajectories in the twelve months before and after cancer diagnosis. Functional trajectory pre-diagnosis, poor physical capability, and incurable stage were independent risk factors for worsening disability post-diagnosis.
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Affiliation(s)
- C J Presley
- The Ohio State University, Medical Oncology (For correspondence and reprints), B424 Starling Loving Hall 320 W, 10th Avenue, Columbus, OH 43214, USA.
| | - Ling Han
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Linda Leo-Summers
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Medical Oncology Duarte, CA, USA
| | - Cary P Gross
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Amy J Davidoff
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Heather G Allore
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Thomas M Gill
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
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18
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de Mol M, den Oudsten BL, Aarts M, Aerts JGJV. The distress thermometer as a predictor for survival in stage III lung cancer patients treated with chemotherapy. Oncotarget 2018; 8:36743-36749. [PMID: 28030796 PMCID: PMC5482693 DOI: 10.18632/oncotarget.14151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression and Health Related Quality of Life have been associated with prognosis in lung cancer. As the Distress Thermometer measures emotional problems and may share similarities with aspects of Health Related Quality of Life, we aimed to retrospectively assess the prognostic value of the Distress Thermometer in lung cancer patients treated with chemotherapy. METHODS Patients with stage III lung cancer who were treated at the day-care oncology unit with chemotherapy containing carboplatin from 2009 to 2014 and in whom a Distress Thermometer was performed at the time of the first cycle of chemotherapy were included in this study. RESULTS In total, one hundred and thirteen patients were included in the analysis. In the simple Cox regression analysis, overall survival did not significantly differ according to Distress Thermometer score. No significant differences in Distress Thermometer score according to stage, histology, (intended) treatment, age, sex, and comorbidity were observed. Also in a multivariable model the Distress Thermometer was not prognostic for overall survival, whereas sex and (intended) treatment was. CONCLUSIONS In this study no prognostic value of the Distress Thermometer could be established in patients with stage III lung cancer treated with carboplatin. Further research is warranted to address this issue.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Mieke Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands
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Thomas M, Spigel DR, Jotte RM, McCleod M, Socinski MA, Page RD, Gressot L, Knoble J, Juan O, Morgensztern D, Isla D, Kim ES, West H, Ko A, Ong TJ, Trunova N, Gridelli C. nab-paclitaxel/carboplatin induction in squamous NSCLC: longitudinal quality of life while on chemotherapy. LUNG CANCER-TARGETS AND THERAPY 2017; 8:207-216. [PMID: 29138610 PMCID: PMC5679693 DOI: 10.2147/lctt.s138570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Longitudinal data on the impact of treatment on quality of life (QoL) in advanced non-small cell lung cancer (NSCLC) are limited. In this palliative setting, treatment that does not deteriorate QoL is key. Here we report longitudinal QoL in patients with squamous NSCLC, receiving ≤4 cycles of nab-paclitaxel/carboplatin combination chemotherapy. Methods Patients received nab-paclitaxel 100 mg/m2 days 1, 8, 15 + carboplatin area under the curve 6 mg•min/mL day 1 (q3w) for four cycles. QoL was assessed by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL-5 Dimensions-5 Levels (EQ-5D-5L) at baseline and each cycle (day 1). Results Two-hundred and six lesion-response-evaluable patients completed baseline + ≥1 postbaseline QoL assessment and were QoL evaluable. LCSS average total score and symptom burden index improved from baseline throughout four cycles. In the LCSS pulmonary symptoms score, 46% of patients reported clinically meaningful improvement (≥10 mm visual analog scale) from baseline. Individual EQ-5D-5L dimensions remained stable/improved in ≥83% of patients; ≈33% reported complete resolution of baseline problems at least once during four cycles. Generally, responders (unconfirmed complete/partial response) had higher scores vs nonresponders. Conclusion In patients with squamous NSCLC, four cycles of nab-paclitaxel/carboplatin demonstrated clinically meaningful QoL improvements, with greater benefits in responders vs nonresponders.
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Affiliation(s)
- Michael Thomas
- Department of Thoracic Oncology/Internal Medicine, Thoraxklinik im Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | | | - Robert M Jotte
- Department of Medical Oncology/Hematology, Rocky Mountain Cancer Centers, Denver, CO
| | | | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | | | | | - Oscar Juan
- Department of Medical Oncology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Daniel Morgensztern
- Department of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dolores Isla
- Department of Medical Oncology, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Howard West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA
| | - Amy Ko
- Celgene Corporation, Summit, NJ, USA
| | | | | | - Cesare Gridelli
- Department of Oncology/Hematology, S.G. Moscati Hospital, Avellino, Italy
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The effects of supportive care interventions on depressive symptoms among patients with lung cancer: A metaanalysis of randomized controlled studies. Palliat Support Care 2017; 15:710-723. [DOI: 10.1017/s1478951517000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACTObjective:Our aim was to examine the effect of supportive care interventions on depressive symptoms in patients with lung cancer.Method:We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and the Chinese Electronic Periodical Services (CEPS) from their inception until September of 2015. We included randomized controlled trial studies that compared standard care with supportive care interventions. The standardized mean difference (SMD) (Cohen's d) was calculated to estimate the effect of interventions. Subgroup analysis was conducted to identify possible sources of heterogeneity.Results:A total of 1,472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = –0.74, CI95% = –1.07 to –0.41), and the effects could be maintained at weeks 4, 8, and 12 of follow-up. Three types of supportive care interventions were identified: psychotherapy combined with psychoeducation, psychoeducation alone, and an exercise program. Both psychotherapy combined with psychoeducation and exercise significantly improved depressive symptoms, while psychoeducation alone did not yield significant effects. The moderating effects indicated that greater improvements in depressive symptoms were found in lung cancer patients with a severe level of depressive symptoms at baseline.Significance of results:Personalized supportive care interventions can be developed based on the main causes of depressive symptoms. Psychotherapy combined with psychoeducation can target the causes of depressive symptoms, including both physical distress and psychological trauma due to lung cancer, while exercise programs can effectively improve depressive symptoms for lung cancer patients with impaired respiratory function.
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Zingone A, Brown D, Bowman ED, Vidal O, Sage J, Neal J, Ryan BM. Relationship between anti-depressant use and lung cancer survival. Cancer Treat Res Commun 2017; 10:33-39. [PMID: 28944316 PMCID: PMC5603309 DOI: 10.1016/j.ctarc.2017.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In recent years, the anti-cancer properties of several commonly used drugs have been explored, with drugs such as aspirin and beta-blockers associated with improved cancer outcomes. Previous preclinical work demonstrated that tricyclic anti-depressants have antitumor efficacy in lung cancer. Our goal was to examine the association between anti-depressant use and survival in lung cancer. MATERIALS AND METHODS We examined the association between use of common anti-depressants and survival in 1,097 lung cancer patients from the NCI-Maryland lung cancer study. The types of anti-depressants included in the study were norepinephrine and dopamine reuptake inhibitors, serotonin reuptake inhibitors, selective serotonin reuptake inhibitors, non-selective serotonin reuptake inhibitors, and tricyclic anti-depressants. Anti-depressant use was extracted from the medical history section of a detailed interviewer-administered questionnaire. Specific use in the three months before a lung cancer diagnosis was determined. Cox portioned hazards modeling was used to estimate the association between anti-depressant use with lung cancer-specific death with adjustment for potential confounding co-factors. RESULTS Anti-depressant use was associated with extended lung cancer-specific survival. In an analysis of specific classes of anti-depressant use, NDRIs and TCAs were associated with improved survival. Importantly, the extended survival associated with anti-depressants was maintained after adjustment for the clinical indications for these drugs, suggestive of a direct effect on lung cancer biology. CONCLUSIONS Considering the manageable and largely tolerable side effects of anti-depressants, and the low cost of these drugs, these results indicate that evaluation of anti-depressants as adjunct therapeutics with chemotherapy may have a translational effect for lung cancer patients.
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Affiliation(s)
- Adriana Zingone
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Derek Brown
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Elise D. Bowman
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Oscar Vidal
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Julien Sage
- Departments of Pediatrics and Genetics, Stanford University, Stanford CA, 94305
| | - Joel Neal
- Department of Medicine, Division of Oncology
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
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